title: Impact of chronic kidney disease on the risk of clinical outcomes in patients with cancer-associated venous thromboembolism during anticoagulant treatment.
abstract: BACKGROUND
  Information on recurrent venous thromboembolic events (VTEs) and major bleeding risks during anticoagulant treatment in patients with cancer-associated VTEs and chronic kidney disease (CKD) is scarce, although it is of relevance in establishing better tailored management strategies in these patients.
  
  
  OBJECTIVE
  We compared risks of recurrent VTEs and major bleeds in cancer-associated VTE patients with and without CKD.
  
  
  METHODS
  A total of 1684 patients diagnosed with a cancer-associated VTE between 2001 and 2011 were followed for 180 days after VTE diagnosis. Patients were treated mainly with low-molecular-weight heparin (LMWH) or vitamin-K antagonists (VKA). Primary outcomes were recurrent VTE and major bleeding. Secondary outcome was fatal bleeding.
  
  
  RESULTS
  Recurrent VTEs occurred in 15.9/100 patient years (py) in patients without CKD (eGFR > 60 mL min(-1) ), 19.5/100 py in those with CKD stage 3A (eGFR 45-60 mL min(-1) ), 14.9/100 py in those with CKD 3B (eGFR 30-45 mL min(-1) ), and 6.8/100 py in patients with CKD 4-5 (eGFR < 30 mL min(-1) ). Major bleeding occurred in 11.4/100 py in patients without CKD, 18.5/100 py in those with CKD stage 3A, 16.0/100 py in those with CKD 3B, and 40.8/100 py in patients with CKD 4-5. Fatal bleeding occurred in 1.1/100 py, 3.4/100 py, 6.3/100 py and 15.7/100 py, respectively. These increased bleeding risks in CKD patients were mainly observed in those on LMWH treatment, not VKA.
  
  
  CONCLUSIONS
  The risk of major bleeding was increased in CKD patients with VTE and cancer, and was most prominent in those treated with LMWH and an eGFR < 30 mL min(-1) . These results indicate that LMWH should be used with caution in this specific population.
authors.affiliation: Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Kooiman
authors.forename: P L
authors.initials: PL
authors.lastname: den Exter
authors.forename: S C
authors.initials: SC
authors.lastname: Cannegieter
authors.forename: S
authors.initials: S
authors.lastname: le Cessie
authors.forename: J
authors.initials: J
authors.lastname: del Toro
authors.forename: J C
authors.initials: JC
authors.lastname: Sahuquillo
authors.forename: J M
authors.initials: JM
authors.lastname: Pedrajas
authors.forename: M V
authors.initials: MV
authors.lastname: Huisman
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006470:Hemorrhage; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D012008:Recurrence; D012042:Registries; D012306:Risk; D013997:Time Factors; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000150:complications*; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014812:Vitamin K
keywords: coumarins; heparin, low-molecular-weight; neoplasm; renal insufficiency, chronic; venous thrombosis